April 20 was the one year anniversary of Texas HB 637 receiving a public hearing – the first ever for a bill related to direct access to physical therapy - with the House Public Health Committee. Actually, it was more like the wee hours of April 21. Close enough.

The committee finally listened to the voice of patients and physical therapists across Texas, although it was a very brief and albeit unsuccessful listen. A one hour hearing at 2:00 am doesn’t tend to attract the general public that are up in arms over these sorts of things, but I digress. With that said, we are now one year later and a mere 8 months before the start of the next legislative session.

Last week there was an interesting editorial piece in the Austin American-Statesman entitled “Texas GOP's health care bill isn't like Obamacare”. It was written by Senator Jane Nelson, author of SB7 (the bill in question) and chairwoman of the Texas Senate Committee on Health & Human Services. If words and espoused principles mean anything at all, and oftentimes they don’t in politics, then we might actually be able to envision Senator Nelson supporting the efforts of physical therapists in the Texas Senate this upcoming session.

Why would I go so far as to expect her support at this point in the on-going (and highly ridiculous) struggle for direct access to physical therapy in Texas? Well, it comes down to her words, right there in front of me, on the written page, in the aforementioned article.

Senator Nelson notes in her article that

“Republicans prefer free-market reforms that contain our costs and preserve the freedom of individuals to make their own health care decisions.”

Let’s start with containing costs. In the world of health care, if you take away the referral requirement for physical therapy, you will save patients millions of dollars before even getting to the treatment itself. How about the freedom of individuals to make their own health care decisions? As it stands, patients can make their own health care decisions unless it involves a physical therapist - the only health care providers in Texas that require a gatekeeper to provide a referral before treatment can be initiated.

Once again, physical therapists already know how to accomplish this – the powers-that-be just choose not to be advocates for the solution. Give patients access to care and let the marketplace solve the rest, much as it has done with other health care providers like physicians and chiropractors.

“… rooted in conservative, free-market principles”

I fully agree with the concept of “free-market principles”. But I can tell you right now, Senator Nelson – limiting access to treatment by physical therapists is simply NOT a free market principle. It may be for the gatekeepers, but it sure isn’t for the physical therapists nor the patients who wish to see them freely and of their own volition.

So, Senator Nelson, I call on you today – one year after HB 637 - to stay true to your words and the principles espoused in your editorial. If you truly believe in these principles, and you are not just making political hay, then I would encourage you to wholeheartedly support direct access to physical therapy in the state of Texas in the next legislative session in 2013. It would be consistent with your stated goals for doing what is best for Texans and their health care. It is consistent with your stated goals of containing costs, improving patient outcomes, protecting patient choice, and free market principles. Patients across the state will appreciate your support.

There is, of course, the little devil in the details. Those details would be the fact that the Texas Medical Association is her number one campaign contributor …

… and we all know how much the TMA vehemently opposes direct access to physical therapy.

But there comes a time when actions will speak louder than words in the Texas Legislature. Now is the time for actions to be consistent with the principles that Senator Nelson has shared with us in last week’s Austin American-Statesman editorial.

Her words, right there in front of all of us.

My fingers are crossed that principles will prevail over lobbying dollars. Constituents, give her a call. I am sure she’d be glad to hear from you.

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Allan Besselink

Allan Besselink, PT, Dip.MDT has a unique voice in the world of sport and health care, one that has been defined by his experiences as physiotherapist, mentor, McKenzie practitioner, coach, innovator, author, educator, patient, and athlete. Read more about Allan, contact him, get updates via email, or connect with him on Twitter, Facebook, Google+ and LinkedIn.

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